Healthcare Provider Details

I. General information

NPI: 1730610700
Provider Name (Legal Business Name): WHITNEY OWENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2017
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 PENDLE HILL AVE
PENDLETON IN
46064-9124
US

IV. Provider business mailing address

1206 PENDLE HILL AVE
PENDLETON IN
46064-9124
US

V. Phone/Fax

Practice location:
  • Phone: 765-602-1429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015279041418479
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: